Reducing Stress in Primary Care Patients

All patients who are receiving or seeking medical care at UPMC CMI practices are given the GAD7(anxiety) and SF-12(quality of life) as a part of their routine medical care. Since this project is occurring at the same practices where a randomized study evaluating treatments for acute back pain (IRB Protocol #015120249), patients with acute back pain will be excluded from this project.

Patient scores become part of the EMR (Epic). A best practice alert will be generated for patients in the age range of 20-65 (inclusive) and in the targeted GAD7 score range (GAD7 ≥5) to prompt the provider to recommend the stress management program (Lantern). The age range was chosen to exclude adolescents who may have different needs, and the geriatric population who is involved in other behavioral studies at these practices.

The Best Practice alert will prompt the clinic staff to gather promotional Lantern materials and pend an order in Epic for stress management registration. When the clinical staff sees the pended order and Lantern materials, clinic staff will decide if the stress management program is appropriate for the patient. The discussion will include a disclaimer that the stress management program does not offer treatment. Clinical staff and patient will also discuss whether or not the patient wishes to consent to participate in Lantern and be contacted Lantern. The clinical staff will question the patient about smartphone or tablet (specifically, iOS or Android) access/availability during the consent process. If the patient is interested, the clinician will submit the order and the patient will sign the consent to participate in the stress management program (Lantern). The use of Lantern is set up at these two CMI sites as part of this research study. It is not for normal clinical care for UPMC patients.

The order generates a paragraph about the stress management program provided to the patient as a written order. The order sends an Epic InBasket to the UPMC Enterprises project team (including the patient's MRN, name, date of birth and contact information). When each order is received, the UPMC Enterprises project team will enter the patient into the registration system, generating a unique ID for each patient.

The registration system will send out an email message to the third-party stress management program (including the unique ID, name, date of birth, and contact information) through a secure VPN connection between UPMC Enterprises and Lantern to inform them of people who have consented.